Night blindness and Crohn's disease.

Signs of malnutrition are common clinical features in Crohn's disease; and bowel resection, commonly needed in these cases, can aggravate malnutrition. These patients are at risk of developing vitamin A deficiency, which can lead to night blindness. We present a 60-year-old male, with history of Crohn's disease and multiple resections for strictures and fistulas leading to short bowel syndrome, with progressive bilateral loss of night vision (nyctalopia). Serum vitamin A level was markedly depleted (11 µg/dL, reference 20-120 µg/dL), and full-field electroretinogram testing demonstrated extinguished scotopic (rod function) responses and decreased amplitudes of photopic responses on 30 Hz flicker (cone function). He was started on vitamin A supplementation (initially intramuscular). His vitamin A level was back to normal (78 µg/dL), and night vision problems subjectively improved. Patients with Crohn's disease should be inquired about night vision problems. The presence of nyctalopia should prompt vitamin A level measurement and ophthalmology referral for further evaluation.

Acute and chronic Staphylococcus epidermidis post-operative endophthalmitis: The importance of biofilm production.

To report two cases of acute and chronic-onset, postoperative Staphylococcus epidermidis endophthalmitis and discuss the virulence and treatment of this saprophytic pathogen. After clinical diagnosis of endophthalmitis, prompt vitreous culture was performed with injection of intravitreal vancomycin 1 mg/0.1 mL and ceftazidime 2.25 mg/0.1 mL. With no improvement after this procedure, a pars plana vitrectomy and lensectomy were performed to further decrease microbial load and repeat the intravitreal antibiotic. The lens and large amounts of fibrotic tissue were removed, and the posterior capsule was stripped. Vitreous cultures grew S. epidermidis sensitive to vancomycin. Intraoperative findings included dense vitreous opacification with extensive vitreous bands and pus extending into the zonules. During the removal of the IOL, adherent pus filaments were removed; however, only a moderate amount of bacteria was detected on the IOL. Further intravitreal vancomycin (1 mg/0.1 mL) and ceftazidime (2.25 mg/0.1 mL) were injected. Staphylococcus epidermidis is widely reported as responsible for medical device-related sepsis. This is mainly due to the production of slime, an exopolysaccharide that eventually leads to the formation of biofilm, one of the most important virulence factors. The failure of intravitreal antibiotic treatment in our two biofilm-associated infections may be due to the considerable amount of slime and pus found extending into the zonules and adherent to the IOL during surgery.

Scleral thickness following fluocinolone acetonide implant (Retisert).

PURPOSE: To evaluate whether intravitreal fluocinolone acetonide (FA) implantation (Retisert) leads to scleral thinning. METHODS: Scleral thickness was measured at the pars plana region (4 quadrants) with anterior segment OCT (Visante) in FA implanted eyes (18) with noninfectious posterior uveitis in comparison to eyes with prior vitrectomy (8), and normal eyes without prior surgery (30). RESULTS: Mean scleral thickness in normal (nonsurgical) eyes was 0.99/0.93/0.88/0.86, and 0.92 mm in the inferonasal/inferotemporal/superotemporal/superonasal quadrants, and overall, respectively. Sclera was thinner in each quadrant of the FA implanted eyes compared to the fellow or nonsurgical eyes, although none reached statistical significance, as the differences were small. However, a few FA implanted eyes demonstrated more dramatic scleral thinning than others. CONCLUSIONS: FA implant appears to lead to statistically nonsignificant scleral thinning overall with few exceptions. Clinicians should be aware of potential scleral thinning in select cases, important for reimplantation and long-term follow-up.